Medical Director - OneHome

Humana • Olympia, WA • 3h ago

Become a part of our caring community and help us put health first

The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health, SNF, DME, dual Medicare/Medicaid and Waiver requests. The Medical Director provides medical interpretation and determinations whether services provided by other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some cases) contracts.

The Medical Director provides medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. All work occurs with a @context of regulatory compliance, and work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand how to operationalize this knowledge in their daily work. The Medical Director works in a structured environment with expectations for consistency in thinking, authorship, meeting departmental expectations, and compliance timelines.

Use your skills to make an impact

Required Qualifications

MD or DO degree

Current and ongoing board certification in an approved ABMS Medical Specialty

A current and unrestricted license in at least one jurisdiction and willing to obtain license, as required, for various states in region of assignment

5+ years of direct clinical patient care experience post residency or fellowship

No sanctions from Federal or State Governmental organizations

The ability to pass credentialing requirements

Excellent verbal and written communication skills with analytic and interpretative skills

Participate in educational activities by attending required conferences and also create content to lead/teach/present for individual subject matter contribution

Preferred Qualifications

Experience in an inpatient environment and/or related to care of a Medicare @type population (disabled or >65 years of age)

Internal Medicine, Family Practice, Geriatrics, Physiatry, Emergency Medicine, Critical Care or hospital based clinical specialists

Ability to function in a dynamic fast paced environment

Commitment to a culture of innovation

Passionate about contributing to an organization's focus on consistency in outcomes, consumer experiences, and a highly engaged team culture

Knowledge and experience with national guidelines such as NCD/LCD, MCG® or InterQual

The Medical Director conducts clinical case reviews of requests received by members of the Medicare population and reports to the Lead Medical Director.

Other duties:

Identify medical management operational improvements, including those within the medical director area

Participate in call rotation which may include weekend coverage

Develop collaborative relationships with Team and key partners within the Medicare Line of Business.

Support Home Solutions as needed

Other activities as assigned by the managing Medical Director

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$223,800 - $313,100 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Application Deadline: 12-31-2025

About us

Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.

Humana

Go to Apply

Share this job

Similar Jobs

Medical Receptionist

MultiCare Health System • Olympia, WA • 3h ago

Hospital & Medical

About Pulse Heart Institute MultiCare's Pulse Heart Institute is a physician led institute with multi-specialty partnership with Cardiothoracic surgery, vascular and cardiovascular service lines. Our team and state-of-th...

3h ago

Go to Apply

Medical Assistant - ENT.

MultiCare Health System • Gig Harbor, WA • 3h ago

Hospital & Medical

You Belong Here. At MultiCare, we strive to offer a true sense of belonging for all our employees. Across our health care network, you will find a dynamic range of meaningful careers, opportunities for growth, safe workp...

3h ago

Go to Apply

Clinic Medical Assistant

Virginia Mason Franciscan Health • Gig Harbor, WA • 3h ago

Hospital & Medical

Job Summary and Responsibilities Sign on bonus available for qualifying candidates! JOB SUMMARY Performs basic patient care/support functions under direction of Provider and within scope of licensure/certification. Basic...

3h ago

Go to Apply

Per Diem Intake Coordinator, Home Health

CenterWell • Olympia, WA • 13h ago

Hospital & Medical

Become a part of our caring community and help us put health first Shift/availability details: Per diem: scheduled up to 19 hours a week. Availability: all 7 days of the week between the hours of 7am-7pm EST. Available t...

13h ago

Go to Apply

Public Health Program Coordinator

CAI • Olympia, WA • 16h ago

Hospital & Medical

Public Health Program Coordinator Req number: R6632 Employment @type: Full time Worksite flexibility: Remote Who we are CAI is a global technology services firm with over 8,500 associates worldwide and a yearly revenue o...

16h ago

Go to Apply

Health Information Specialist I - 4929

Datavant • Olympia, WA • 16h ago

Hospital & Medical

Datavant is a data platform company and the world's leader in health data exchange. Our vision is that every healthcare decision is powered by the right data, at the right time, in the right format. Our platform is power...

16h ago

Go to Apply

Account Executive - Healthcare

SHI • Olympia, WA • 1d ago

Hospital & Medical

About Us Since 1989, SHI International Corp. has helped organizations change the world through technology. We've grown every year since, and today we're proud to be a $15 billion global provider of IT solutions and servi...

1d ago

Go to Apply

Certified Medical Assistant

Actalent • Olympia, WA • 2d ago

Hospital & Medical

Job Title: Certified Medical Assistant | Multiple Locations Across Washington Job Description Support physicians and other healthcare providers by handling patient scheduling, maintaining medical records, and assisting w...

2d ago

Go to Apply

Coder II - OP Physician Coding (Ortho Surgery)

Baylor Scott & White Health • Olympia, WA • 2d ago

Hospital & Medical

SPECIALTY SCOPE FOR THIS CODER II POSITION TO INCLUDE BUT NOT LIMITED TO: Upper Extremity: Shoulders: Total/Hemi Arthroplasty, Arthroscopy, Rotator cuff repair, Biceps tenodesis, Acromioplasty, Distal claviculectomy, Sup...

2d ago

Go to Apply

Physical Therapist (School)

Amergis • Shelton, WA • 3d ago

Hospital & Medical

The Physical Therapist is responsible for performing student evaluations, as well as providing and documenting therapy services in accordance with plan of care developed for each student and per physician's orders when a...

3d ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.